GUIDELINE IMPLEMENTATION OF THE "OTTAWA ANKLE RULES" IN GERMANY

M. Zirr¹, M. Alfuth², R. Prill³

Background: Acute injuries of the ankle joint belong to the most common sports injuries. Being most sensitive for fractures, x-ray is often used to identify. An easy manual testbattery for the examination of ankle joint injuries, being sensitive for the presence of fractures too, are the „Ottawa Ankle Rules“ (OAR). The adherence to these guidelines could minimize the proportion of unnecessary x-ray examinations.

Purpose: With regard to accessible literature, the OAR show high diagnostic accuracy. However, corresponding guidelines in Germany describe that the OAR are not implemented as a matter of routine. The aim of the study is to determine the causes of the deficient deployment of the OAR.

Methods: The subjective relevance of the individual contents of the OAR as a parameter of the implementation progress, was analyzed with the help of a survey in the German-speaking area. Thereby 200 participants should assess the content of the OAR concerning the relevance of its items for clinical diagnosis. They were composed of n=100 physicians and n=100 physiotherapists, all of them working in the outpatient field. The relevance should be assessed on a scale from 1 to 9. A score between 7 and 9 was defined as clinically relevant.

Results: Both of the examined groups evaluate the OAR not as relevant enough, to use it unconditionally in the clinical examination. Several contents of the OAR, for example the examination of the ability to walk or the palpation of the distal fibula, were nevertheless evaluated as very relevant. 83 % of the physicians still assess imaging as very relevant.

Conclusion(s): The results verify that the OAR are not implemented as a matter of routine in Germany. A reason for that might be, that several contents of this guideline are not assessed as relevant enough. Furthermore, the relevance of medical imaging which was valued as high, might influence the assessment of the OAR.

Implications: In the course of the trend towards evidence-based medicine, the implementation of the OAR represents a further development in the acute diagnosis of ankle injuries. This would have the potential to reduce costs and capacities in clinical settings and radiology departments.
OARs have a sensitivity of almost 100%. However, in order for them to be used in everyday professional life, national guideline must be adapted to increase the acceptance of the OAR.

Funding, acknowledgements: none

Keywords: injury, ankle, diagnostic

Topic: Orthopaedics

Did this work require ethics approval? No

Institution: P3 – Physio Praxis Prill

Committee: Dr. Robert Prill

Reason: voluntary survey, anonym data